Trending
DEAR DR. ROACH: Please explain why there are standard tests that we all know we should do as we age, such as a colonoscopy, a mammogram, a skin check, eye exams, etc. But nobody ever says that you should do at least one CT scan or MRI for the deadliest of them all -- pancreatic cancer! It’s rarely diagnosed until stage 4!
My husband had really bad stomach pain that radiated to his back. Although it only happened twice, we proactively got a blood test and an ultrasound, which were fine. Our gastroenterologist recommended a CT scan, which looked OK, but we weren’t completely sure.
He had an MRI, which found a mass in the tail of pancreas. We’re awaiting biopsy results now, but we know it’s a small mass without any other organs being affected. But why isn’t this standard testing after age 60 or 65? -- J.F.
ANSWER: The simplest answer is that screening for pancreatic cancer in people who are at an average risk isn’t effective. The studies that have been done haven’t shown a benefit.
Pancreatic cancer isn’t common. If 10,000 people were followed for 10 years, we’d expect 10 or 12 cases during this time. The tests aren’t perfect; they miss some of the cases. The tests can also say that something looks like pancreatic cancer, leading to additional testing and even surgery, only for the patient to find out in the end that it wasn’t cancer at all. A CT scan also has a risk of radiation.
Even when pancreatic cancer is caught early, the prognosis has remained poor. I recall several high-profile people in the past 20 years who had pancreatic cancer that was found early but still succumbed to the disease. I’m hopeful, however, that with an entire new category of treatment (RAS-targeted drugs), we’ll be able to more effectively treat people, especially when the cancer’s caught early.
Unfortunately, for now, there’s more harm than good that’s being done in average-risk people with pancreatic screening tests, and experts recommend against any screening tests. In people who are at a very high risk (a family history with a genetic variant that predisposes them to pancreatic cancer), screening may be appropriate in people who are willing to take the risk of unnecessary procedures in the hope of curing pancreatic cancer early. This type of screening should take place in a specialized center with experts in pancreatic cancer.
DEAR DR. ROACH: I had a 20-second nystagmus episode. I started taking baby aspirin. Was this a transient ischemic attack (TIA)? Should I be worried? — C.R.
ANSWER: Nystagmus is a movement of the eye muscles that occurs in several different patterns. I’ve never had a patient come in with this concern, as nystagmus is typically a sign (a physical exam finding) rather than a symptom (a concern that a patient brings in). I’m not sure whether you noticed nystagmus by looking in the mirror or through changes in your vision -- like the sense that the world’s moving or jumping (“oscillopsia” is the technical name), or double vision.
There are many causes of nystagmus. Conditions that cause vertigo, such as vestibular neuritis, Meniere’s disease, and benign positional vertigo, can cause vertigo that’s associated with nystagmus. Strokes and TIAs are possible but much less common. Some medications can cause nystagmus, as can alcohol.
An examination by an expert (a neurologist) is the next step that I recommend you take, as the exam will immediately point to a narrow set of diagnoses.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
All Rights Reserved